Individuals suffering from a neurological disorder often must relearn to walk. Improving walking ability is critical to rehabilitation. Often, the initial stages of therapy begin with evaluating the patient's balance and gait to assess their fall risk. After a neurological incident, experts also recommend balance and gait be assessed and corrected by training if necessary. Studies have shown that incorrect weight shifting, e.g., leaning too far forward during standing or walking, improper foot placement during walking, etc., is the most frequent cause of falling, encompassing 41% of falls. Fall prevention and exercising is also important for elderly individuals as, according to the Center for Disease Control, one out of three older people fall each year. Older adults and persons with neurological disorders such as Parkinson's disease, Multiple Sclerosis, stroke, and peripheral neuropathy have gait impairments and, thus, are at a higher risk of falling. These individuals require repetitive stepping and gait mechanics training.
Patients initially use rehabilitation products under a therapist's supervision. After discharge, the patient is expected to continue the prescribed therapy at home. Current balance and gait training products used in clinics are often not affordable for some clinics or for clients to buy for home use. It follows that some patients cannot follow the prescribed treatment protocol because the tools needed are not portable and available for home use. Further, patients trying to perform stepping and balance exercises at home also often lack the appropriate feedback and require guidance to ensure they are performing the prescribed exercises correctly
Another related drawback of prior art devices is that they are difficult to set up and use correctly. The more complex the device is to set up, especially for impaired individuals or non-professionals, correct and consistent use will decrease, which will decrease the therapy's effectivity. That is, patients need continued practice with good form and training to maintain their current level of progress or continue to improve on the progress they have made during professionally-conducted therapy. Experts have advised that balance training be conducted permanently to contract age-related declines in balance performance. The need for an easy to use system is paramount to encourage patients or individuals struggling with motor issues to continue their training and therapy.
There are many types of exercise equipment that aim to improve balance, proprioception, and sensory processing, but they do not provide both balance and gait training and cannot be used both in the clinic and in a patient's home. For example, some prior art devices provide square or circle shaped force plates that accommodate a single foot. These devices cannot incorporate all the gait phases, train gait mechanics, and adapt balance to different surfaces and textures. That is, prior art devices that simply provide force plates do not address walking from one surface to another at various heights and surface densities.
For example, proprioception (joint position) machines are disclosed in U.S. Pat. No. 7,004,895 to Perry et al. This machine perturbs in all directions for reactive balance but does not train voluntary balance needed for stepping during gait. It also does not allow feedback for proprioception of the hip during gait for step length, width, or height or at the ankle/foot for a smooth transition heel to toe to negotiate all terrains and over obstacles.
In addition, balance products manufactured by NeuroCom International, Inc. (See, for example, U.S. Pat. Nos. 5,476,103, 5,551,445, and 6,010,465, measure an individual's balance task performance and use force-plates on which a patient stands to record changes in the position of the center of force exerted by the feet against the support surface. Gait mechanics and stepping more than one step is not possible with these devices. NeuroCom's products do not use textured materials in the shape of a footprint to provide more accurate feedback for stepping, which we described in further detail below. Alternatively, feedback provided for center of force changes is provided on a screen, which is not ideal.
Many balance systems such as the Wii Fit® produced by Nintendo® or Balance Master® produced by Natus® primarily provide visual feedback received from an underfoot force plate and do not stimulate the mechanoreceptors in the feet. These products also fail to provide a closed-loop feedback when the patient's eyes are closed or their head is turned to challenge the vestibular system.
WO2001008755 to Ganville et al. discloses targets laid out grids (15 cm squares). The target pads are pressure sensitive but not shaped as a footprint with increased sensitivity to width, height, and length. The disclosed device also does not provide textured targets. Further, as the disclosed invention is more suitable for gait mechanics from heel contact to forefoot (loading response), the grid targets cannot determine location of both foot and heel contact. Lunges can hit the target but, again, are one-dimensional with only small sensitivity for width, and step height is not addressed. Although the lamina, e.g., the mat, may also have different textured surfaces for the user to perform the exercises on, the textures are not in the shape of a footprint and do not provide step position feedback. U.S. Pat. No. 8,900,165 to Jeka is directed to a balance training system for improving a user's postural control by providing visual feedback regarding the user's center of mass (CoM) via a display.
U.S. Patent Application Publication No. 2015/0364059 to Marks et al. is directed to an exercise mat that includes sensors that provide real-time feedback using visual and auditory systems to correct weight distribution of yoga poses. It provides no tactile feedback and does not contemplate training gait mechanics.
Health care professionals often use visual cues such as laser lights (see, for example, U.S. Patent Application Publication No. 2007/0255186 and U.S. Pat. Nos. 8,702,567 and 9,084,712), and/or tape marks positioned on the floor to provide step or gait training feedback. These methods can help increase step length, but can detrimentally increase patient dependence on visual cues for balance. Further, these methods often force the patient to look down, which results in poor posture and decreased integration of their vestibular system. Research shows older adults and people with Parkinson's disease over rely on their visual system for balance. Visual reliance/dependence can increase an individual's fall risk in visually stimulating environments, when turning one's head, or dark areas.
WO1987001574A1 to Bugarini discloses a system that allows a walkway to be scanned in real-time during a patient's gait analysis at a sampling frequency higher or equal to 50 Hz, and distributing the support pressures exerted by the sole of the feet to be determined in a full gait cycle (double step). Bugarini provides a walkway of sufficient size to measure double step and evaluate the foot pressures, but does not allow treatment protocols to improve gait mechanics, challenge the sensory systems, provide sensory re-weighting and adapt balance to different surfaces and heights. This system is not for a patient to use at home.
U.S. Patent Application Publication No. 2011/0184225 to Whitall relates to training step length and step rate ratio for a given velocity in response to a rhythmic auditory cue which allows spatial and temporal gait parameters and gait speed can be actively changed. Although this device provides step length feedback through auditory cues, it does not incorporate the foot/ankle mechanics and heel toe rocker movement. For example, a patient can step with a flat foot and it could not provide feedback to change the gait mechanics.
The prior art also includes boards/mats that attempt to improve step length with varied heights. For example, U.S. Patent Application Publication No. 2004/0009845 to Johnson uses a gait board for inside parallel bars to assist step length and height using hurdles, but does not incorporate textured foot prints for foot placement and use of auditory cues for improved initial contact and loading response. A patient can take a large step over a hurdle and with a flat foot which does not coincide with a normal gait.
JP5692929B2 to Aoyama describes an exercise mat that is supposed to prevent falling. The mat has an upper walking surface that includes a color-coded pattern that includes at least two or more different colors, which relies on the visual system for balance with decreased integration of the somatosensory and vestibular system. This mat's aim is to improve gaze behavior requiring patients to look down using this mat for proper stepping rather than stepping to a textured target or auditory feedback for proper gait mechanics. This mat also fails to provide a closed-loop feedback when the patient's eyes are closed or their head is turned to challenge the vestibular system.
U.S. Patent Application Publication 2004/0214692 to Koenig discloses an exercise mat having a grid composed of intersecting straight lines and sequential reference indicia. The grid lines and marks can be a different colors, thicknesses, and types (such as dashed lines), and can have a convex or concave protrusion associated with the surface of the exercise mat that differentiates one mark from another. The grid lines may also assist in exercise alignment, to measure stretching progress from one week to another week, or to identify correct dance movements. Koenig's mat relies on visual cues for step position does not provide the feedback needed for gait or incorporate textures and foam to train the somatosensory and vestibular systems. Feedback on step position with progressions with head turns or eyes closed cannot be performed on Koenig's mat due to the user must look down for feedback if they are in correct position.
U.S. Patent Application Publication No. 2013/0180048 to Saltzman generally relates to an exercise yoga mat, where the mat has printed indicia for measuring distance along the surface of the mat.
U.S. Pat. No. 5,096,188 to Shen discloses a device for magnetic therapy and foot massage. Although interchangeable pebble-like convex moldings can be arranged along the board, the moldings are not in the shape of a foot and cannot be used for foot placement to determine limb position (proprioception) and for gait mechanics. It also does not incorporate different foam densities to challenge the vestibular system or provide sensory re-weighting (stepping from one texture surface to another).
U.S. Patent Application Publication No. 2005/0170935 to Manser provides an exercise surface for increasing the proprioceptive demands on the foot, ankle, and lower leg. The exercise surface includes a plurality of projections extending upward therefrom, and is adapted for use as an exercise mat or a treadmill belt. The textured surfaces may challenge a person's proprioception but it does not provide feedback for foot placement position (step length, width, or height) or proper gait mechanics at initial contact and push-off Manser does not include varied foam densities to challenge the vestibular system as he is only challenging the somatosensory system (proprioception) His art also does not allow training for sensory re-weighting for postural control, adapting from changing environmental conditions and available sensory information (i.e. hard surface—somatosensory to foam-vestibular)
U.S. Pat. No. 7,955,224 and U.S. Patent Application Publication No. 2009/0062076 to Curley is directed to a yoga mat with hand and feet placement stations that provide tactile and audio feedback. Curley was designed to assist visually impaired to perform yoga poses and does not address gait mechanics or integration of all the balance systems. Further, Curley does not include varied heights and foam densities to challenge the vestibular system or provide sensory re-weighting for postural control
U.S. Pat. No. 9,211,437 to Soba teaches a yoga and exercise mat with attachable markers. The markers are affixed to the mat and help yoga performers or exercisers maintain a proper posture, enhance their physical form, achieve desired positioning, and to greatly minimize a potential safety hazard and the risk of injury. In particular, the attachable markers are manufactured in an array of different shapes, styles, and colors to aide visually impaired individuals. Soba, however, does not teach the use of markers that provide tactile or auditory feedback.
U.S. Patent Application Publication No. 2008/0066343 to Sanabria-Hernandez is directed to an invention that helps mitigate “toe-walking” and or “heel-walking” by training; namely by prompting an auditory stimulus as positive reinforcement when pressure is placed on an inappropriate portion of the foot. Step length, sensory processing, and re-weighting to different surfaces, etc. is not measured or could be trained
U.S. Pat. No. 5,929,332 to Brown discloses a sensor for monitoring the condition of strike force a foot within a shoe. More specifically, Brown provides a computerized foot pressure microcomputer that receives signals from sensors and analyzes them to determine if a critical situation exists regarding whether sufficient foot pressure is applied by a walking patient. Similarly, U.S. Patent Application Publication No. 2003/0009308 to Kertley is directed to a combination of sensors in a shoe sole wherein data from the sensors is stored and relayed to a monitoring assessment for determining running/walking cadence of a test subject. These inventions do not combine sensory input to enhance balance and stepping.
Additionally, U.S. Pat. No. 6,405,606 to Walczyk et al. is directed to a shoe system that provides biofeedback relating to a gait vector. This reference discloses the combination of a gait and forced sensor and provides some physical measurement to measure a patient's force placed upon an injured limb during use. In an additional example, some children's footwear may provide auditory stimulus when the child places pressure on a heel portion of a sandal, the auditory stimulus is made by a simple squeaky-air pressure type mechanism for entertainment (generating a “squeak-sound”).
U.S. Pat. No. 7,191,644 to Haselhurst teaches a gait system designed to assist with the treatment of subjects with a lack of sensation due to nerve damage or amputation. Such individuals are often unable to tell when their foot contacts the floor. The system includes a removable insole placed inside the shoe which proportionally senses touchdown of the limb.
WO2001036051 to Avni teaches an adaptive weight bearing monitoring system for rehabilitating injuries affecting the mobility of a lower limb of a patient. At least one set of sensor units detects weight forces applied to at least two monitored locations of at least one limb. The sensors generate dynamic weight input signals from each of said monitored locations. Much like the references described herein related to footwear, this reference is irrelevant to a mat that provides biofeedback to a patient or therapist assessing gait and balance.
Further, there are also many products designed to help foot position, stance, and stride for athletes especially in golf, baseball, and dancing. None include training for proper gait mechanics and sensory processing. For example, U.S. Patent Application Publication No. 2006/0154220 to Toniolo is a dance training device that helps teach individuals proper foot position and body movement. The training device allows the individual to determine the correct position of his or her feet in relation to a ballet bar.
U.S. Pat. No. 6,102,818 to Hamilton is directed to an athletic training device for teaching proper baseball hitting, throwing, and fielding techniques. The mat includes positional indicia that indicate proper stance and stride positions. One side of the mat has positional indicia for teaching proper technique for hitting. U.S. Pat. No. 5,642,880 to Wiseman teaches a similar device with pressure sensitive areas for temporarily indicating the position of the batter's feet after they swing the bat.
U.S. Pat. No. 5,118,112 to Bregman teaches a system for analyzing golfer balance and weight shifts from one foot to the other and between the heel and toe of each foot during a golf swing. The disclosed system generally comprises two foot pads capable of measuring weight on each pad and on the front and rear portions of each pad, a display, a sound sensor for sensing the impact of a golf club against a golf ball, and a microprocessor system for receiving information from the pads and generating the display. The results may be used by the golfer to adjust his swing toward the optimum.
Finally, U.S. Patent Application Publication No. 2004/004336 to Chou provides a dancing machine that includes a base that has stepped stages wherein each of the two-step stages has a plurality of step on pads. A single unit is located on the front of the base as provide lights, music, and a display that shows the number of calories burned. Chou's dancing machine does not combine sensory inputs to enhance balance, stepping and proper gait mechanics.
While the prior art mentioned hereinabove teaches various forms of yoga and exercise mats with distinct functionalities, they do not measure step length and width for gait.
Increased gait variability predicts falls among community-living older adults and those with neurological diagnoses. This invention intends to address this issue to improve symmetry of stepping. The following articles provide additional insight related to balance and gait issues faced by some neurological patients:    Jozef Púčik, Marián Šaling, Tomáš Lukáč, Oldřich Ondráček, and Martin Kucharík, “Assessment of Visual Reliance in Balance Control: An Inexpensive Extension of the Static Posturography,” Journal of Medical Engineering, vol. 2014, Article ID 248316, 9 pages, 2014. doi:10.1155/2014/248316.    John J. Jeka, Leslie K. Allison, and Tim Kiemel. The Dynamics of Visual Reweighting in Healthy and Fall-Prone Older Adults. Journal of Motor Behavior Vol. 42, Iss. 4, 2010.    Park J-H, Kang Y-J, Horak F B. What Is Wrong with Balance in Parkinson's Disease? Journal of Movement Disorders. 2015; 8(3): 109-114. doi:10.14802/jmd.15018.    Fay Horak. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age and Ageing 2006; 35-S2.    King L A, Horak F B. Delaying Mobility Disability in People with Parkinson Disease Using a Sensorimotor Agility Exercise Program. Physical Therapy. 2009; 89(4):384-393. doi:10.2522/ptj.20080214.    B. Galna, A. T. Murphy, M. E. Morris, Obstacle crossing in people with Parkinson's disease: foot clearance and spatiotemporal deficits, Hum. Movement Sci. 29 (2010) 843-852.    Hausdorff, J. M. (2007) Gait dynamics, fractals and falls: Finding meaning in the stride-to-stride fluctuations of human walking. Hum. Mov. Sci., 26, 555-589.    N. Königa, 1, W. R. Taylora, 1, C. R. Baumannb, N. Wenderothc, N. B. Singha Revealing the quality of movement: A meta-analysis review to quantify the thresholds to pathological variability during standing and walking. Neuroscience & Biobehavioral Reviews Volume 68, September 2016, Pages 111-119.    Konig N, Singh N B, Baumann C R, Taylor W R. Can Gait Signatures Provide Quantitative Measures for Aiding Clinical Decision-Making? A Systematic Meta-Analysis of Gait Variability Behavior in Patients with Parkinson's Disease. Frontiers in Human Neuroscience. 2016; 10:319. doi:10.3389/fnhum.2016.00319.
It is a long-felt need to provide a training mat that is portable, easy to use, affordable, and that addresses many of the prior art drawbacks. Embodiments of the invention described herein were developed to help people reach their fullest potential by achieving individual goals and preventing falls. A science-based approach combined with a clinical need led to the development of a feedback mat to assess and train step position, gait symmetry, and mechanics. The portable mat disclosed herein also allows therapists to evaluate and specifically train the appropriate balance system (the visual, the somatosensory, and/or the vestibular system), that can be easily applied in the clinic or the patient's home.